Predetermination approved... but I'm still worried. Advice?

[TXcourtney04]

After 1 predetermination rejection, a VERY lengthy appeal, and 5 months of waiting and hounding every customer service agent at BCBS of TX, I finally received what APPEARS to be an approval letter. It reads:

"Based on the documentation submitted, 21147, 21196, 21085, 99215, 99243, 70355, for 524.03, 524.01, 524.23, 478.0, 524.27, 524.50, V41.6, 784.00, 524.69, 327.53 meets medical policy criteria. This plan does provide coverage for this service.
However, predetermination of benefits does not guarantee payment. Benefits are always subject to other applicable requirements such as preexisting conditions, limitations and exclusions, payment of premium and eligibility at the time of care and services that are provided. Also, note that some services require precertification."


The 1st paragraph includes all the diagnosis codes and procedure codes submitted by my doctor. From this part alone, I would assume that I could proceed with the preparation for this surgery confident that all required procedures would be covered.

This 2nd paragraph scares me. My initial predetermination letter was rejected because of an EXCLUSION in my plan stating that orthognathic surgery is not covered past the age of 19 (I'm 27). Also, is there a difference between "predetermination" and "precertification"? I thought that's what this was.

I can't help but feel like this is setting me up for some sort of denial of payment by my insurance company. Does anyone have any knowledge or experience on this matter?

Any suggestions or advice would be greatly appreciated!